Healthcare Provider Details

I. General information

NPI: 1093917221
Provider Name (Legal Business Name): JESSE GODDARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 HARRISBURG PIKE STE 310
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2106 HARRISBURG PIKE STE 310
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-5945
  • Fax: 717-544-5944
Mailing address:
  • Phone: 717-544-2644
  • Fax: 717-544-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD459118
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD459118
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: